Evacuated with a spoon

In 1836 a doctor from rural Ireland, J.L. McCarthy, encountered a highly unusual case which he then reported to The Lancet. The journal deemed it worthy of publication, although it is unlikely that many of its readers would ever need to know how to treat a patient suffering from this particular complaint:

On Thursday, the 8th instant, I was sent for to visit John Leary, aged 35, living at Toames, three miles from hence, a steward in charge of a farm belonging to a gentleman of the name of Penrose. I found the man in bed, labouring under the most agonizing pains, which he referred to the anus, rectum, and loins. He was bathed in sweat; his countenance expressed the greatest anxiety, but he suffered no headache nor delirium.

When Dr McCarthy examined the patient he found his tongue ‘coated with a thick white fur’; he was horribly thirsty, and also had a pressing urge to urinate and defecate, but was unable to do either. Suspecting the bowels were the problem, the doctor decided to investigate further.

On making an examination per anum, I found its verge considerably swollen and inflamed, with great contraction of the sphincters, and so tender and irritable, that it was with much difficulty that the patient would allow me to proceed with the examination. He said he had been ill during the last three days; that during the first and second days of his attack, he only felt occasional fits of pain in the anus and loins, but that for the last sixteen hours, or thereabouts, he was in extreme agony, with but occasional slight intermissions. He had not had an anal evacuation for the last four days, and from ten o’clock pm. on the previous evening had not passed any urine up to the time when I saw him, which was one o’clock pm on the following day.

Fifteen hours with a full bladder is an awfully long time; you can understand his discomfort.

He said to me, that being for some time previous to his illness superintending the thrashing out of a large quantity of Mr. Penrose’s wheat, he had, as was often his habit, eaten some of the grain as he proceeded, and to that he attributed his illness.

‘Some of the grain’. Patients with self-inflicted illnesses sometimes tell half-truths out of sheer embarrassment. And so it proved in this case.

He went on the second day of his illness to the Macroom Dispensary, where he was ordered a dose of castor oil, but no effect followed its exhibition.

A mild laxative. As it turned out, this case of constipation needed something rather more drastic.

Having by mistake omitted to bring at catheter with me, I sent home for one, and in the meantime proceeded to examine the rectum internally. With considerable difficulty I introduced my little-finger, well oiled, into that cavity, and found it extremely distended. It was, in fact, completely blocked up with a hard mass of undigested wheat. The agony which the patient suffered from this exploration, forced me to desist for a short time, when I determined on attempting to extract some of the wheat from the bowel.

A sensible course of action. Now, what implement do you think would be most suitable for extracting faecal matter from a patient’s rectum?

I accordingly procured a small eggspoon, and having well oiled the handle, introduced it into the rectum, and detached and brought away from the mass about two ounces of semi-masticated wheat. By this means I obtained a little more room, so that I was enabled to force into the rectum a few small pieces of mutton suet, which I allowed to remain until they had melted.

Mutton suet sounds a very strange thing to be introducing to that orifice, and at this juncture, but judging by the outcome it was an inspired idea.

This had the effect of lubricating the part and softening the contents of the cavity; so that on a second attempt with the spoon-handle I succeeded in clearing out about ten ounces more of the wheat, the patient all this time complaining of almost intolerable suffering. Having desisted for a time in order to allow him some rest, he felt an urgent desire to go to stool, but the attempt was unsuccessful, owing to the tenderness and constriction of the anus. He was, however, able to urinate, and voided about two and a half pounds of fluid.

That’s something, anyway.

On making my next examination, I found that the attempts to evacuate the bowels had brought down more of the wheat into the rectum, which was again filled to distention, but the mass was not so hard as in the first instance; and on again operating, I succeeded in removing about twenty ounces more. The patient now expressed himself as much relieved. I had by this time in all brought away about two pounds of wheat.

That’s about a kilogram: a large bagful. This from a man who admitted only to eating ‘some’ of the grain.

As I found his pulse full, quick, and bounding, I bled him to ℥xxv, when he became faint.

℥xxv is 25 ounces (the ‘℥’ is the symbol for an ounce in the apothecaries’ system of weights and measures), or just over a pint.

I then had the rectum stuped for about an hour, and gave him a draught containing an ounce of Castor Oil, fifty drops of tincture of Henbane, and an ounce of Cinnamon water.

‘Stuped’ means ‘dressed with a poultice’ – a piece of cloth was soaked in hot water and then applied to the affected area. Henbane, a toxic plant related to deadly nightshade, was traditionally used for its anaesthetic and analgesic properties. Cinnamon was often prescribed for disorders of the digestive system, as it had been since antiquity.

Half an hour afterwards an enema was administered, followed by a purgative draught. Six hours afterwards I found him free from pain, and in a sound sleep. His bowels had been much affected by the enema and medicines, and an immense quantity of wheat, with some white starchy stuff, had passed from his bowels. The anus continued tender for a few days, but by keeping the bowels soluble with small doses of the Magnesian salts, he perfectly recovered.

An excellent outcome. Dr McCarthy prefaces his report by observing that ‘a fatal result was near occurring’, and he’s probably right: without intervention the patient’s bladder or bowel might have ruptured, causing peritonitis, systemic infection, septic shock and death. Nineteenth-century therapies were often ineffectual or downright dangerous, but in this case common sense – if we overlook the bleeding – and quick thinking saved a life.